MEMBERSHIP APPLICATION/RENEWAL
We
invite your involvement in making Survivor Guide an effective, member-driven organization. We value your support and welcome
you to renew your membership.
Name: __________________________________________________________
Address: _______________________________________________________
Postal Code: ___________________
Phone:___________________________
Fax: __________________________
E-mail: ___________________________
Type of membership:
Student/Senior $ 5.00 _____ General Membership $10.00
_____
Agency Member $15.00 _____ Corporate Sponsorship $33.00 _____
* Active Volunteers or Active Participants may request that their fees are waived.
Please indicate which of these categories represents you.
This is a new membership �� a renewal ��
Also, enclosed is my donation cheque for $_______ payable to Survivor
Guide Visa/MasterCard #_______________ Expiry Date: _____ Signature:_____________
I am interested in volunteering with Survivor Guide ��
Yes, I would like to be active and receive mailings related to Survivor Guide activities. ��
Survivor Guide helps survivors to make long term positive changes with courage, confidence & empowered
choices.
I support the mission statement, and show my support by
registering as a member of
this organization. (Please sign your name below)
______________________________________________________You’re Signature
Date _______________________________________
Thank you!
Janet Menezes &
Cherie Ann Day
Founders www.SurvivorGuide.ca
